负压封闭引流联合小腿皮神经皮瓣修复足踝部软组织缺损

Vacuum sealing drainage combined with crural neurocutaneous flap to repair soft tissue defect of ankle and foot

目的探讨应用负压封闭引流(VSD)联合小腿皮神经皮瓣修复足踝部软组织缺损的临床效果。方法对18例足踝部软组织缺损患者创面行清创、VSD治疗1~2个疗程,二期应用小腿皮神经皮瓣(隐神经皮瓣5例,腓肠神经皮瓣13例)逆行移位修复足踝部软组织缺损创面。皮瓣切取面积为5.0 cm×6.0 cm^8.0 cm×10.5 cm。结果 18例中16例皮瓣成活;1例远端部分坏死,经换药后痊愈;1例大部分坏死,患者拒绝再手术。17例患者经3~24个月随访,皮瓣质地柔软、弹性好,皮瓣外形及足踝部功能满意,供区植皮全部成活,外形满意。9例随访12个月时皮瓣恢复部分感觉。结论 VSD可以控制感染,刺激肉芽组织生长,为小腿皮神经皮瓣提供良好成活条件;小腿皮神经皮瓣是足踝部软组织缺损创面修复的良好手段;二者联合应用是修复足踝部软组织缺损较理想的治疗方法。

Objective To investigate the clinical efficiency of vacuum sealing drainage（ VSD） combined with crural neurocutaneous flap to repair soft tissue defect of ankle and foot. Methods 18 cases of ankle and foot soft tissue defect were treated with primary debridement,VSD treatment for 1 ~ 2 courses. In the second stage,the retrograde transposition of crural neurocutaneous flap（ 5 cases of saphenous nerve flap,13 cases of sural nerve flap） was used to repair soft tissue of defect of foot and ankle. The area of cutting skin flap was 5. 0 cm × 6. 0 cm ~ 8. 0 cm × 10. 5 cm.Results In 18 cases,16 flaps survived; 1 case got distal part necrosis,recured after dressing change; 1 case got necrosis,the patient refused to surgery. Seventeen cases got 3 ~ 24 months follow-up,the skin flap was soft and elastic. The appearance of the flap and the function of ankle were good. The donor site all survived,and the appearance was satisfactory. 9 cases had 12 months of follow-up,their flaps recovered part of sense. Conclusions VSD can control the infection,stimulate the growth of granulation tissue,and provide a good survival condition for crural neurocutaneous flap; crural neurocutaneous flap is a good method of repairing soft tissue defect of foot and ankle wounds; the combination of the two methods is an ideal treatment method for reconstruction of foot and ankle soft tissue defects.